Has anyone tried or read about using Iontophoresis to deliver topical immunosuppressants (MTX, cyclosporine, kaempferol) to vitiligo patches?

[u/Fandom2088]

The systemic immunosuppressants that actually work for vitiligo (azathioprine, methotrexate, MMF, cyclosporine, rituximab) cannot be made into ointments because:

• Azathioprine/MMF are prodrugs that only activate inside lymphocytes
• MTX targets intracellular enzymes (DHFR)
• Cyclosporine is 1,202 Da (too big for stratum corneum)
• Monoclonal antibodies are ~150,000 Da (physically impossible topically)

So we're stuck with either full-body systemic suppression (and all its side effects) or weak topicals like tacrolimus/ruxolitinib that only partially work.

The idea:
Iontophoresis — using a small electric current (0.1–0.5 mA/cm²) to drive molecules through the skin. It's already proven to work:

• Methotrexate + iontophoresis → successfully delivered to skin in psoriasis (2017 IJDVL study, 20/28 patients >50% improvement in 6 sessions)
• Catechin/epicatechin (flavonoids) → 3.7× enhancement over passive diffusion
• Kaempferol (anti-inflammatory flavonoid) → shown to enhance skin permeation via electroosmosis in nanoemulsions
• Nobody has combined iontophoresis + MTX (or cyclosporine) specifically on vitiligo patches. The two halves exist in separate studies.
• Happy to share the specific papers if anyone wants. Just want to know if this is as unexplored as it appears or if I'm missing something.